title: Lay counselors' ability to deliver counseling for behavior change.
abstract: OBJECTIVE
  Options for Health is an evidence-based sexual risk reduction intervention based on motivational interviewing (MI). Thirty-nine antiretroviral adherence lay counselors were trained to deliver Options for Health to help their patients to optimize their antiretroviral treatment adherence. An evaluation of counselors' ability to deliver the intervention after 35 hr of training revealed that counselors struggled with elements of the 8-step Options protocol and failed to achieve proficiency in MI. The current study aimed to determine the impact of refresher training and supervision on counselors' proficiency in the intervention.
  
  
  METHODS
  Audio-recordings of counseling sessions were collected for 22 of 39 counselors after 18 hr of refresher training and supervision had been delivered over a 12-month period. Recordings were transcribed, translated, and analyzed for fidelity to the Options protocol and the MI approach. Analysis was conducted using the Motivational Interviewing Treatment Integrity Tool and an instrument developed by the researchers. Results were compared to findings from an evaluation of counselors' performance immediately following the initial 35-hr training.
  
  
  RESULTS
  Counselors improved their delivery of some intervention steps, but not others; their use of micro-counseling skills and therapeutic approach improved to such an extent that they closely approximated the MI approach.
  
  
  CONCLUSIONS
  This study contributes evidence for the positive impact of ongoing training and supervision on lay health worker practice. Although counselors did not achieve complete proficiency in the Options protocol, refresher training and supervision improved counselors' basic counseling communication skills and therapeutic approach, enabling them to deliver better quality counseling for behavior change.
authors.affiliation: Health Systems Research Unit.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dewing
authors.affiliation: Health Systems Research Unit.
authors.forename: Cathy
authors.initials: C
authors.lastname: Mathews
authors.affiliation: HIV/AIDS, STIs and TB Research Programme.
authors.forename: Allanise
authors.initials: A
authors.lastname: Cloete
authors.affiliation: School of Public Health.
authors.forename: Nikki
authors.initials: N
authors.lastname: Schaay
authors.affiliation: HIV/AIDS, STIs and TB Research Programme.
authors.forename: Leickness
authors.initials: L
authors.lastname: Simbayi
authors.affiliation: Department of Psychology.
authors.forename: Johann
authors.initials: J
authors.lastname: Louw
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D062405:Motivational Interviewing; D011361:Professional Competence; D060728:Reproductive Health; D040242:Risk Reduction Behavior